Sunday, December 30, 2012

Sleep: Protecting An Essential Life Rhythm

Many college students do not sleep well.  In fact, the typical student pattern can best be described as chaotic.  In many cases these patterns exacerbate and even trigger poor mental health outcomes.  Bipolar and other mood disorders, for example, are known to be sensitive to inadequate or unhealthy sleep rhythms.  Sometimes sleep problems are caused by factors outside their direct control, such as loud roommates, a medical condition, or living near a train track.  In these circumstances vulnerable students should consider working toward changes in their health and living situations, admittedly not always an easy thing to do.  More often than not, however, a student's sleeping problem is caused by poor "sleep hygiene", or poor choices about sleep that are within their ability to alter.

Due to their youth and general level of energy and vitality, traditional-aged students may grossly underestimate their ability to cope with chaotic life rhythms.  The average 20-year old can in fact rebound from sleep deprivation better than, say, the average 40-year old.  But this subjective feeling may mask an underlying deterioration which may be occurring, even at the cellular level.  So, students can pull off all-nighters for a time, but that habit is soon to catch up with them in the form of worsening mood, impaired ability to focus and concentrate, and diminished academic or athletic performance.

One simple set of guidelines to follow: pick and stick to a regular, reasonable rise time, avoid daytime naps, and use the bed only for sleep and other relaxing activity.  Seven to nine hours of nighttime sleep may be ideal.  But there are other tips which may be helpful.

Here is a list of practices conducive to good sleep, adapted from the American Academy of Sleep Medicine (2002):

  • Try to sleep only when you are drowsy.
  • If you are unable to fall asleep or stay asleep, leave your bedroom and engage in a quiet activity elsewhere.  Do not permit yourself to fall asleep outside the bedroom.  Return to bed when - and only when - you are sleepy.  Repeat this process of often as necessary throughout the night.
  • Maintain a regular arise time, even on days off work and on weekends.
  • Use your bedroom only for sleep and relaxing activity.
  • Avoid napping during the daytime.  If daytime sleepiness becomes overwhelming, limit nap time to a single nap of less than one hour, no later than 3 pm.
  • Distract your mind.  Lying in bed unable to sleep and frustrated needs to be avoided.  Try reading or watching a videotape or listening to books on tape.  It may be necessary to go into another room to do these.
  • Avoid caffeine within four to six hours of bedtime.
  • Avoid the use of nicotine close to bedtime or during the night.
  • Do not drink alcoholic beverages within four to six hours of bedtime.
  • While a light snack before bedtime can help promote sound sleep, avoid large meals.
  • Avoid strenuous exercise within six hours of bedtime.
  • Minimize light, noise, and extremes in temperature in the bedroom.

Sunday, December 16, 2012

Newtown

As we learn more about yet another unspeakable tragedy we also ponder in frustration over the state of mental health care in America.  While mass violence forever changes the landscapes of educational and community institutions, we look for courageous leaders who will take the reins and improve the accessibility, affordability and effectiveness of mental health services for the most vulnerable among us.


In higher education settings, the lives of every member of a campus community have been and will be deeply affected by fears of violence.  Alert systems, enhanced reporting and communication methods concerning potential threats, response teams and capable public safety operations are all now a part of daily campus life.  We have gotten better at identifying and providing initial responding to students in distress.  But what do we do after that?

The answer is a feeble one.  In many jurisdictions, there aren't enough psychiatric beds to hold all the individuals who may be of concern.  There aren't statutes which permit a mental health professional to issue an order to law enforcement to detain a threatening individual and hold him or her in a hospital   The process of petitioning for commitment in these same hospitals can take weeks, even longer.  The average stay in those hospitals may be two to five days.  For many, especially the un- and under-insured, there may be a long wait to follow up with a mental health professional after discharge.  Hospitals are closing, patients are being released into "community care", but there may be no such thing in reality.  In short, all the current incentives, intentional or not, are to block access to care.

As you see in the news, these issues occur at a time of threat and anxiety.  The families of the dead and maimed are looking for support and answers.  We are learning more about the factors behind and indicators of risk for potentially violent individuals.  But we can tell them more about that than we can about what to do with them.  This is a national travesty and it must be addressed.  Please press your legislators to take action.  Demand that they develop sound, sustainable funding models for state services.  Demand that they sponsor legislation that provides a rapid and seamless system of detainment and treatment for people who threaten our safety.  Tell them to support mental health insurance parity.  The folks in Newtown, Portland, Aurora, Oak Creek, Tucson, Blacksburg and many other past and future communities are waiting for our help.